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Peng L, Liu Y, Lv C, Shen W, Wu Y, Zhang J, Fu Z. Evaluating the stage of deep vein thrombosis: the diagnostic accuracy of shear wave elastography and super-microvascular imaging. Quant Imaging Med Surg 2024; 14:6882-6894. [PMID: 39281150 PMCID: PMC11400703 DOI: 10.21037/qims-23-1822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/22/2024] [Indexed: 09/18/2024]
Abstract
Background Assessing the age of deep vein thrombosis (DVT) is crucial for guiding treatment approaches. Two-dimensional shear-wave elastography (2D-SWE) and super-microvascular imaging (SMI), as emerging techniques for tissue elasticity assessment and intrathrombus microvascular analysis, are pivotal for accurate thrombus age determination. This research endeavors to classify DVT into acute, subacute, and chronic ages utilizing these imaging methods. Methods The study is a prospective, single-center, inpatient investigation that utilized convenience sampling for participant recruitment. Patients with a symptom duration of <6 months who were found to have lower-extremity DVT on ultrasound (US) between January 2021 and March 2022 after craniocerebral trauma (CT) or bone injury (BI) operations were included in this study. Participants were divided into three groups based on the duration of DVT, measured from the first diagnosis of thrombosis by US to the follow-up with 2D-SWE and SMI: acute (≤14 days), subacute (15-30 days), and chronic (31 days to 6 months) All patients underwent 2D-SWE and SMI using an Aplio i700 Ultrasound System equipped with a PLT-1005BT line array probe. Diagnostic performance was assessed using the area under the receiver operating characteristic (ROC) curve. Results The maximum value of the elastic modulus for DVT (DVT_Emax), the mean value of the elastic modulus for DVT (DVT_Emean), and SMI's flow distribution scoring pattern for DVT (SMI_scoring) emerged as significant predictors for acute and chronic, with high area under the ROC curve (AUC) of acute [AUC (95% confidential interval): 0.95 (0.89-0.97), 0.96 (0.91-0.98), 0.93 (0.88-0.97) in 39 patients] and chronic [AUC (95% confidential interval): 0.88 (0.81-0.93), 0.94 (0.88-0.97), 0.91 (0.84-0.95) in 51 patients], respectively. However, these indices had lower efficacy for subacute prediction [AUC (95% confidential interval): 0.51 (0.42-0.60), 0.54 (0.46-0.63), 0.53 (0.44-0.62), in 47 patients]. Combining DVT_Emean with SMI_scoring improved performance in predicting subacute: 0.90 (0.83-0.94) than related features alone. Conclusions Both 2D-SWE and SMI can be used to assess acute and chronic DVT in patients with CT and BI after surgeries. This combination is a promising adjunctive technique for identifying the subacute phase of DVT in these patients.
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Affiliation(s)
- Lin Peng
- Department of General Practice, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Yan Liu
- Department of Ultrasound, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Chunju Lv
- Department of Ultrasound, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Wenyi Shen
- Department of Ultrasound, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Yanqing Wu
- Department of Ultrasound, Xintai People's Hospital, Tai'an, China
| | - Jiajun Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Zunfeng Fu
- Department of Ultrasound, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
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Ward RE, Martinez-Correa S, Tierradentro-García LO, Hwang M, Sehgal CM. Sonothrombolysis: State-of-the-Art and Potential Applications in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 11:57. [PMID: 38255371 PMCID: PMC10814591 DOI: 10.3390/children11010057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/15/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
In recent years, advances in ultrasound therapeutics have been implemented into treatment algorithms for the adult population; however, the use of therapeutic ultrasound in the pediatric population still needs to be further elucidated. In order to better characterize the utilization and practicality of sonothrombolysis in the juvenile population, the authors conducted a literature review of current pediatric research in therapeutic ultrasound. The PubMed database was used to search for all clinical and preclinical studies detailing the use and applications of sonothrombolysis, with a focus on the pediatric population. As illustrated by various review articles, case studies, and original research, sonothrombolysis demonstrates efficacy and safety in clot dissolution in vitro and in animal studies, particularly when combined with microbubbles, with potential applications in conditions such as deep venous thrombosis, peripheral vascular disease, ischemic stroke, myocardial infarction, and pulmonary embolism. Although there is limited literature on the use of therapeutic ultrasound in children, mainly due to the lower prevalence of thrombotic events, sonothrombolysis shows potential as a noninvasive thrombolytic treatment. However, more pediatric sonothrombolysis research needs to be conducted to quantify the safety and ethical considerations specific to this vulnerable population.
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Affiliation(s)
- Rebecca E. Ward
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (R.E.W.); (S.M.-C.); (L.O.T.-G.); (M.H.)
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Santiago Martinez-Correa
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (R.E.W.); (S.M.-C.); (L.O.T.-G.); (M.H.)
| | - Luis Octavio Tierradentro-García
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (R.E.W.); (S.M.-C.); (L.O.T.-G.); (M.H.)
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Misun Hwang
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (R.E.W.); (S.M.-C.); (L.O.T.-G.); (M.H.)
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Chandra M. Sehgal
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Bertsch T, Behringer W, Blaschke S, Body R, Davidson S, Müller-Olling M, Guo G, Rieger A, Wahl A, Horner D, Sun Y, Turnes L, Sonner U, Hoffmann M. Deep vein thrombosis and pulmonary embolism: a prospective, observational study to evaluate diagnostic performance of the Tina-quant D-Dimer Gen.2 assay. Front Cardiovasc Med 2023; 10:1142465. [PMID: 38169956 PMCID: PMC10759223 DOI: 10.3389/fcvm.2023.1142465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 11/17/2023] [Indexed: 01/05/2024] Open
Abstract
Background D-Dimer testing is a diagnostic tool for exclusion of deep vein thrombosis (DVT) and pulmonary embolism (PE). This study evaluated the diagnostic performance of the Tina-quant® D-Dimer Gen.2 assay (Roche Diagnostics International Ltd, Rotkreuz, Switzerland) in patients with low/intermediate pre-test probability of DVT/PE using standard, age-, and clinical probability-adjusted cut-offs. Methods In this prospective, observational, multicenter study (July 2017-August 2019), plasma samples were collected from hospital emergency departments and specialist referral centers. DVT/PE was diagnosed under hospital standard procedures and imaging protocols. A standard D-dimer cut-off of 0.5 µg fibrinogen equivalent units (FEU)/ml was combined with the three-level Wells score; cut-offs adjusted for age (age × 0.01 µg FEU/ml for patients >50 years) and clinical probability (1 µg FEU/ml for low probability) were also evaluated. An assay comparison was conducted in a subset of samples using the Tina-quant D-Dimer Gen.2 assay and the previously established routine laboratory assay, STA-Liatest D-Di Plus assay (Stago Deutschland GmbH, Düsseldorf, Germany). Results 2,897 patients were enrolled; 2,516 completed the study (DVT cohort: 1,741 PE cohort: 775). Clinical assessment plus D-dimer testing using the standard cut-off resulted in 317 (DVT) and 230 (PE) false positives, and zero (DVT) and one (PE) false negatives. Negative predictive value (NPV) was 100.0% (95% confidence interval [CI]: 99.7%-100.0%) and 99.8% (95% CI: 98.8%-100.0%) for DVT and PE, respectively. After age-adjustment, NPV was 99.9% (95% CI: 99.6%-100.0%) and 99.1% (95% CI: 97.8-99.7) for DVT and PE, respectively. False positive rates decreased (>50%) in clinical probability-adjusted analyses vs. primary analysis. In the assay comparison, the performances of the two assays were comparable. Conclusion The Tina-quant D-Dimer Gen.2 assay and standard D-dimer cut-off level combined with the three-level Wells score accurately identified patients with a very low probability of DVT/PE.
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Affiliation(s)
- Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Wilhelm Behringer
- Department of Emergency Medicine, Faculty of Medicine, University of Jena, Jena, Germany
| | - Sabine Blaschke
- Emergency Department, University Medical Center Göttingen, Göttingen, Germany
| | - Richard Body
- Division of Cardiovascular Sciences, Core Technology Facility, University of Manchester, Manchester, United Kingdom
- Emergency Department, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Simon Davidson
- Roche Diagnostics International Ltd, Rotkreuz, Switzerland
| | | | - Ge Guo
- Roche Diagnostics, Indianapolis, IN, United States
| | | | | | - Daniel Horner
- Emergency Department, Salford Royal NHS Foundation Trust, Salford, United Kingdom
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
| | - Yuli Sun
- Roche Diagnostics GmbH, Penzberg, Germany
| | - Lucia Turnes
- Agent Representing Roche Diagnostics GmbH, Penzberg, Germany
| | - Ulrich Sonner
- Agent Representing Roche Diagnostics GmbH, Penzberg, Germany
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Santini P, Esposto G, Ainora ME, Lupascu A, Gasbarrini A, Zocco MA, Pola R. Ultrasound Elastography to Assess Age of Deep Vein Thrombosis: A Systematic Review. Diagnostics (Basel) 2023; 13:2075. [PMID: 37370970 DOI: 10.3390/diagnostics13122075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND AND AIMS Deep-vein thrombosis (DVT) is a widely diffused condition, and its accurate staging has major clinical and therapeutic implications. Ultrasound elastography (UE) is a rapidly evolving imaging technique that allows quantification of elastic tissue properties and could play a crucial role in determining thrombus age. The aim of this review is to find clinical evidence regarding the application of UE in the evaluation of DVT and its usefulness in differentiating thrombosis age. METHODS A literature search of clinical studies was performed to identify the ability of UE of discriminate acute, subacute, and chronic DVT. Heterogeneity and publication bias were calculated. In accordance with the study protocol, a qualitative analysis of the evidence was planned. The results were summarized with a comprehensive summary table of study characteristics and baseline characteristics of participant patients. RESULTS Nine studies matched the predetermined eligibility requirements for this systematic review regarding the risk of bias; the greatest criticalities were found within the domains of patient selection and index test. Based on the quality assessment, two publications were excluded from the qualitative synthesis because of the presence of significant applicability concerns. Among the seven studies that were considered eligible for qualitative synthesis, four evaluated strain elastography and three evaluated shear-wave elastography. Despite significant differences concerning study design, thrombus age definitions, and patient characteristics, nearly all studies demonstrated an increase in thrombus stiffness according to DVT age. CONCLUSIONS UE could play a key role in routine ultrasound examination of DVT. The measurement of thrombus stiffness has a high biological plausibility and its use is supported by the finding of a correlation between the stiffness and the progression of the DVT age.
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Affiliation(s)
- Paolo Santini
- Section of Internal Medicine and Thromboembolic Diseases, Department of Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy
| | - Giorgio Esposto
- Section of Internal Medicine and Thromboembolic Diseases, Department of Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy
| | - Maria Elena Ainora
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy
| | - Andrea Lupascu
- Section of Medical Angiology, Department of Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy
| | - Maria Assunta Zocco
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy
| | - Roberto Pola
- Section of Internal Medicine and Thromboembolic Diseases, Department of Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy
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Hemorrhagic risk prediction in coronary artery disease patients based on photoplethysmography and machine learning. Sci Rep 2022; 12:19190. [PMID: 36357443 PMCID: PMC9649686 DOI: 10.1038/s41598-022-22719-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022] Open
Abstract
Hemorrhagic events are the main focus of attention during antithrombosis therapy in patients with coronary artery disease (CAD). This study aims to investigate the potential of using photoplethysmography (PPG) and machine learning techniques to assess hemorrhagic risk in patients with CAD. A total of 1638 patients with CAD were enrolled from January 2018 to October 2019, among which 114 patients were observed to have at least one positive event. Importantly, 102 patients with 9933 records were finally retained for analysis in this study. Participants were required to collect data using the portable PPG acquisition device and the specially designed Android APP. The data was collected and uploaded to a remote server. Based on collected PPG signals, we extracted features in a total of 30 dimensions from time-domain, frequency-domain, and wavelet packet decomposition. Logistic regression, support vector regression, random forest, and XGBoost regression models were established to achieve hemorrhagic risk evaluation, and then, their performances were compared. In total, 10 features extracted from PPG showed statistical significance (p < 0.01) between negative and positive groups. The newly established XGBoost model performed best in the hemorrhagic risk evaluation experiment, wherein the mean area under the curve (AUC) with tenfold cross-validation was 0.762 ± 0.024 and the sensitivity and specificity were 0.679 ± 0.051 and 0.714 ± 0.014, respectively. We established a data acquisition system for PPG signal collection, and demonstrated that a set of features extracted from PPG and the proposed machine learning model are promising in the evaluation of hemorrhagic risk among patients with CAD. In comparison with the traditional HAS-BLED score, the proposed method can obtain the quantitative risk prediction probability from a single PPG record, which has the advantages of dynamics and continuity, and can provide timely feedback for doctors' antithrombotic treatment, which is of great significance for doctors to quickly determine the effectiveness of the treatment and adjust the timely treatment plans accordingly.
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Gollamudi J, Sartain SE, Navaei AH, Aneja S, Kaur Dhawan P, Tran D, Joshi J, Gidudu J, Gollamudi J, Chiappini E, Varricchio F, Law B, Munoz FM. Thrombosis and thromboembolism: Brighton collaboration case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2022; 40:6431-6444. [PMID: 36150973 DOI: 10.1016/j.vaccine.2022.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 01/27/2023]
Abstract
This is a Brighton Collaboration case definition of thrombosis and thromboembolism to be used in the evaluation of adverse events following immunization, and for epidemiologic studies for the assessment of background incidence or hypothesis testing. The case definition was developed by a group of experts convened by the Coalition for Epidemic Preparedness Innovations (CEPI) in the context of active development of SARS-CoV-2 vaccines. The case definition format of the Brighton Collaboration was followed to develop a consensus definition and defined levels of certainty, after an exhaustive review of the literature and expert consultation. The document underwent peer review by the Brighton Collaboration Network and by selected expert reviewers prior to submission.
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Affiliation(s)
- Jahnavi Gollamudi
- Department of Medicine, Section of Hematology, Baylor College of Medicine, Houston, TX, USA
| | - Sarah E Sartain
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Amir Hassan Navaei
- Pediatric Critical Care, Transfusion Medicine & Coagulation, Pediatrics and Pathology & Immunology Departments, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St, Suite WB110, Houston 77021, TX, USA
| | - Satinder Aneja
- Department of Pediatrics, School of Medical Sciences & Research, Sharda University, Gr Noida, India
| | | | - Dat Tran
- Oregon Health Authority, Public Health Division, Acute and Communicable Disease Prevention Section, Portland, OR, USA
| | - Jyoti Joshi
- International Centre for Antimicrobial Resistance Solutions (ICARS), Orestads Boulevard 5, 2300 Copenhagen, Denmark
| | - Jane Gidudu
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Elena Chiappini
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | | | - Barbara Law
- SPEAC, Brighton Collaboration, Independent Consultant, Vancouver, BC, Canada
| | - Flor M Munoz
- Department of Pediatrics, Section of Infectious Diseases, and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA.
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Cerullo E, Jones HE, Carter O, Quinn TJ, Cooper NJ, Sutton AJ. Meta-analysis of dichotomous and ordinal tests with an imperfect gold standard. Res Synth Methods 2022; 13:595-611. [PMID: 35488506 PMCID: PMC9541315 DOI: 10.1002/jrsm.1567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/14/2022] [Accepted: 03/29/2022] [Indexed: 11/07/2022]
Abstract
Standard methods for the meta-analysis of medical tests, without assuming a gold standard, are limited to dichotomous data. Multivariate probit models are used to analyse correlated dichotomous data, and can be extended to model ordinal data. Within the context of an imperfect gold standard, they have previously been used for the analysis of dichotomous and ordinal test data from a single study, and for the meta-analysis of dichotomous tests. However, they have not previously been used for the meta-analysis of ordinal tests. In this article, we developed a Bayesian multivariate probit latent class model for the simultaneous meta-analysis of ordinal and dichotomous tests without assuming a gold standard, which also allows one to obtain summary estimates of joint test accuracy. We fitted the models using the software Stan, which uses a state-of-the-art Hamiltonian Monte Carlo algorithm, and we applied the models to a dataset in which studies evaluated the accuracy of tests, and test combinations, for deep vein thrombosis. We demonstrate the issues with dichotomising ordinal test accuracy data in the presence of an imperfect gold standard, before applying and comparing several variations of our proposed model which do not require the data to be dichotomised. The models proposed will allow researchers to more appropriately meta-analyse ordinal and dichotomous tests without a gold standard, potentially leading to less biased estimates of test accuracy. This may lead to a better understanding of which tests, and test combinations, should be used for any given medical condition.
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Affiliation(s)
- Enzo Cerullo
- Biostatistics Research Group, Department of Health SciencesUniversity of LeicesterLeicesterLeicestershireUK
- Complex Reviews Support UnitUniversity of Leicester & University of GlasgowGlasgowUK
| | - Hayley E. Jones
- Population Health SciencesBristol Medical School, University of BristolBristolUK
| | | | - Terry J. Quinn
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotlandUK
| | - Nicola J. Cooper
- Biostatistics Research Group, Department of Health SciencesUniversity of LeicesterLeicesterLeicestershireUK
- Complex Reviews Support UnitUniversity of Leicester & University of GlasgowGlasgowUK
| | - Alex J. Sutton
- Biostatistics Research Group, Department of Health SciencesUniversity of LeicesterLeicesterLeicestershireUK
- Complex Reviews Support UnitUniversity of Leicester & University of GlasgowGlasgowUK
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Mohamed HN, Bashir AM, Mohamed YG. Multiple Venous and Pulmonary Artery Thrombosis as a Presenting Complaint of Nephrotic Syndrome-Case Report and Challenges in Management. Vasc Health Risk Manag 2022; 18:589-593. [PMID: 35924007 PMCID: PMC9342885 DOI: 10.2147/vhrm.s371373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
Abstract
Nephrotic Syndrome (NS) patients are prone to develop deep venous thrombosis as a complication. But it is unusual to present initially with multiple venous thrombosis and pulmonary artery thrombosis before the diagnosis of NS. Here, we present 60 years old female patient with a known history of diabetes mellitus who presented with shortness of breath and lower limb edema for 2 weeks. CT angiography showed thromboembolism at the right main pulmonary artery and its bronchus intermedius, lower and segmental with right lower lobe small pulmonary infarction and inferior vena cava (IVC) thrombosis extending in both renal veins, right common and left common iliac vein, moderate ascites. Her 24-hour urinary protein was 6.7g. a diagnosis of NS was reached and she was admitted to the ward. Anticoagulation with heparin and warfarin, methyl prednisone, and furosemide was initiated. After she become clinically stable, she was discharged with oral medications. Awareness of the complication of nephrotic syndrome is important not only to nephrologists but to all physicians. Using contrast-enhanced computed tomography to diagnose multiple venous and pulmonary arterial thrombosis is critical. Additionally, it is known that steroid-resistant NS, like membranous glomerulonephritis, are more susceptible to the complication of thromboembolism than steroid-sensitive NS. Contrast venography is used to diagnose DVT. CTPA is the gold standard test for pulmonary embolism.
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Affiliation(s)
- Hawa Nuradin Mohamed
- Department of Internal Medicine, Mogadishu Somali Turkey, Training and Research Hospital, Mogadishu, Somalia
| | - Ahmed Muhammad Bashir
- Department of Internal Medicine, Mogadishu Somali Turkey, Training and Research Hospital, Mogadishu, Somalia
- Correspondence: Ahmed Muhammad Bashir, Department of Internal Medicine, Mogadishu Somali Turkey, Training and Research Hospital, Mogadishu, Somalia, Email
| | - Yahye Garad Mohamed
- Department of Radiology, Mogadishu Somali Turkey, Training and Research Hospital, Mogadishu, Somalia
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9
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Honoré ML, Pihl TH, Busk-Anderson TM, Flintrup LL, Nielsen LN. Investigation of two different human d-dimer assays in the horse. BMC Vet Res 2022; 18:227. [PMID: 35705958 PMCID: PMC9199134 DOI: 10.1186/s12917-022-03313-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 05/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background D-dimer has value as a marker of thrombosis in critically ill horses and can provide additional information about prognosis. However, there are currently no equine species-specific d-dimer assays available, nor has there been any formal investigation of the applicability of human d-dimer assays in horses, so it is unknown, which assay performs best in this species. The aim of this study was therefore to evaluate and compare two human d-dimer assays for their applicability in horses. The study included four groups of horses: clinically healthy horses, horses with gastrointestinal (GI) disease and mild systemic inflammation based on low serum amyloid A (SAA) (low SAA group), horses with GI disease and strong systemic inflammation based on high SAA (high SAA group) and, horses with thrombotic GI disease caused by Strongylus vulgaris (also called non-strangulating intestinal infarction (NSII)) (NSII group). The assays evaluated were the STAGO STA-Liatest D-di + (Stago) and NycoCard™ D-dimer (NycoCard). Intra- and inter-coefficients of variation (CV) were assessed on two d-dimer concentrations, and linearity under dilution was evaluated. A group comparison was performed for both assays across the four groups of horses. A Spaghetti plot, Spearman Correlation, Passing Bablok regression and Bland–Altman plot were used to compare methods in terms of agreement. Results Ten horses were included in the clinically healthy group, eight in the low SAA group, eight in the high SAA group, and seven in the NSII group. For the Stago assay, intra- and inter-CVs were below the accepted level except for one inter-CV. The NycoCard assay did not meet the accepted level for any of the CVs. The linearity under dilution was acceptable for both the Stago and NycoCard. In the group comparison, both methods detected a significantly higher d-dimer concentration in the high SAA and NSII groups compared to the clinically healthy group. Method agreement showed slightly higher d-dimer concentrations with NycoCard compared to Stago. The overall agreement was stronger for the lower d-dimer concentrations. Conclusion Both the Stago and the NycoCard were found to be applicable for use in horses but were not directly comparable. Supplementary Information The online version contains supplementary material available at 10.1186/s12917-022-03313-5.
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Affiliation(s)
- Marie Louise Honoré
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences (SUND), University of Copenhagen, Hoejbakkegaard Allé 5a, 2630, Taastrup, Denmark.
| | - Tina H Pihl
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences (SUND), University of Copenhagen, Hoejbakkegaard Allé 5a, 2630, Taastrup, Denmark
| | - Tanne M Busk-Anderson
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences (SUND), University of Copenhagen, Hoejbakkegaard Allé 5a, 2630, Taastrup, Denmark
| | - Laura L Flintrup
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences (SUND), University of Copenhagen, Hoejbakkegaard Allé 5a, 2630, Taastrup, Denmark
| | - Lise N Nielsen
- Section for Internal Medicine, Oncology and Clinical Pathology, Faculty of Health and Medical Sciences (SUND), University of Copenhagen, Dyrlaegevej 16, 1870, Frederiksberg C, Denmark
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10
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Xue Z, Tu W, Gao J, Dong Z, Yuan J, Lang J. Optimal preoperative timing for prevention of deep vein thrombosis (DVT) in patients over 60 years of age with intertrochanteric fractures. Eur J Trauma Emerg Surg 2022; 48:4197-4203. [PMID: 35445814 DOI: 10.1007/s00068-022-01969-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 03/15/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the incidence and risk factors of preoperative DVT in elderly patients with intertrochanteric fracture of the femur and determine the optimal preoperative time. METHODS Electronic medical records of 358 patients over 60 years of age with intertrochanteric fractures from May 1, 2016, to May 1, 2019, were retrospectively analyzed. The preoperative group was divided into DVT and non-DVT. Univariate analysis was used for preliminary comparison, and multivariate logistic regression analysis was used to identify independent risk factors associated with DVT development. ROC curve was drawn to analyze the specificity and sensitivity of risk factors for DVT diagnosis. The diagnostic value of the model was analyzed by the ROC curve of multivariable combined diagnosis. RESULTS A total of 358 patients who met the criteria were enrolled. The total prevalence of DVT before surgery was 8.38%. Multivariate logistic regression analysis showed that smoking status, preoperative time, albumin (ALB), D-dimer level, diabetes mellitus, and hypertension were independent risk factors for preoperative DVT. Preoperative time has the best sensitivity and specificity for diagnosing the occurrence of preoperative DVT. The ROC curve analysis model of multivariable combined diagnosis has a better diagnostic value. CONCLUSIONS In this study, elderly patients with intertrochanteric femur fracture had a higher incidence of deep vein thrombosis before surgery. Early identification of DVT-related risk factors may contribute to individualized risk assessment and preventing adverse outcomes in patients with intertrochanteric fractures.
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Affiliation(s)
- ZhiQiang Xue
- Department of Orthopaedics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang Province, China
| | - WangJie Tu
- Department of Orthopaedics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang Province, China
| | - JianQing Gao
- Department of Orthopaedics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang Province, China
| | - ZeTao Dong
- Department of Orthopaedics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang Province, China
| | - JianDong Yuan
- Department of Orthopaedics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang Province, China
| | - JunZhe Lang
- Department of Orthopaedics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang Province, China.
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11
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Incidence and risk factors of preoperative deep venous thrombosis following hip fracture: a retrospective analysis of 293 consecutive patients. Eur J Trauma Emerg Surg 2022; 48:3141-3147. [DOI: 10.1007/s00068-021-01861-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 12/12/2021] [Indexed: 12/27/2022]
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12
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Li L, Zhou J, Huang L, Zhen J, Yao L, Xu L, Zhang W, Zhang G, Chen Q, Cheng B, Gong S, Cai G, Jiang R, Yan J. Prevention, treatment, and risk factors of deep vein thrombosis in critically ill patients in Zhejiang province, China: a multicenter, prospective, observational study. Ann Med 2021; 53:2234-2245. [PMID: 34797177 PMCID: PMC8805816 DOI: 10.1080/07853890.2021.2005822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/08/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The aim of this study is to investigate the prevention and treatment patterns of deep vein thrombosis (DVT) in critically ill patients and to explore the risk factors for DVT in people from Zhejiang Province, China. MATERIALS AND METHODS This study prospectively enrolled patients admitted in intensive care units (ICUs) of 54 hospitals from 09/16/2019 to 01/16/2020. The risk of developing DVT and subsequent prophylaxis was evaluated. The primary outcome was DVT occurrence during ICU hospitalisation. Univariate and multivariate logistic regression were performed to determine the risk factors for DVT. RESULTS A total of 940 patients were included in the study. Among 847 patients who received prophylaxis, 635 (75.0%) patients received physical prophylaxis and 199 (23.5%) patients received drug prophylaxis. Fifty-eight (6.2%) patients were diagnosed with DVT after admission to the ICU, and 36 patients were treated with anticoagulants (all patients received low molecular weight heparin [LMWH]). D-dimer levels (OR = 1.256, 95% CI: 1.132-1.990), basic prophylaxis (OR = 0.092, 95% CI: 0.016-0.536), and physical prophylaxis (OR = 0.159, 95% CI: 0.038-0.674) were independently associated with DVT in ICU patients. The short-term survival was similar between DVT and non-DVT patients. CONCLUSIONS DVT prophylaxis is widely performed in ICU patients. Prophylaxis is an independent protective factor for DVT occurrence. The most common treatment of DVT patients is LMWH, although it might increase the rate of bleeding.Key messagesThis is the only multicenter and prospective study of DVT in ICUs in China.d-dimer levels were independently associated with DVT in ICU patients.Prophylaxis was an independent protective factor for DVT occurrence in ICU.
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Affiliation(s)
- Li Li
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Jia Zhou
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Liquan Huang
- Department of Critical Care Medicine, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang, China
| | - Junhai Zhen
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Lina Yao
- Department of Critical Care Medicine, Ningbo Yinzhou People’s Hospital, Yinzhou, Zhejiang, China
| | - Lingen Xu
- Department of Critical Care Medicine, Xinchang Hospital of Traditional Chinese Medicine, Xinchang, Zhejiang, China
| | - Weimin Zhang
- Department of Critical Care Medicine, Dongyang People's Hospital, Dongyang, Zhejiang, China
| | - Gensheng Zhang
- Department of Critical Care Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qijiang Chen
- Department of Critical Care Medicine, Ninghai First Hospital, Ninghai, Zhejiang, China
| | - Bihuan Cheng
- Department of Critical Care Medicine, The 2 School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shijin Gong
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Guolong Cai
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Ronglin Jiang
- Department of Critical Care Medicine, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang, China
| | - Jing Yan
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - (Zhejiang Provincial Critical Care Clinical Research Group)
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China
- Department of Critical Care Medicine, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang, China
- Department of Critical Care Medicine, Ningbo Yinzhou People’s Hospital, Yinzhou, Zhejiang, China
- Department of Critical Care Medicine, Xinchang Hospital of Traditional Chinese Medicine, Xinchang, Zhejiang, China
- Department of Critical Care Medicine, Dongyang People's Hospital, Dongyang, Zhejiang, China
- Department of Critical Care Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Critical Care Medicine, Ninghai First Hospital, Ninghai, Zhejiang, China
- Department of Critical Care Medicine, The 2 School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
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13
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Huwae TECJ, Heifan A, Sugiarto MA. Correlation of Wells Score, Caprine Score, and Padua Score with Risk of Hypercoagulation Condition Based on D-dimer in Intra-articular, Periarticular, and Degenerative Fracture Patients of Inferior Extremity. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Surgery for large joint areas can increase risk of venous thromboembolism, which can be in the form of pulmonary embolism or deep vein thrombosis (DVT). As much as, 40–60% of hemostasis abnormalities, specifically hypercoagulable diseases, are suspected of causing this condition. The risk of developing DVT can be assessed using a physiological examination such as Wells score, Caprini score, and Padua score. The scoring systems assess some of the patient’s symptoms and risk factors for increasing the incidence of DVT. Hypercoagulation conditions can be assessed using D-dimer, which is often considered a gold standard in measuring hypercoagulation conditions or as an indicator of DVT.
AIM: We aimed to investigate correlation of Wells Score, Caprine Score, and Padua Score with risk of hypercoagulation condition based on d-dimer in intra-articular, periarticular, and degenerative fracture patients of inferior extremity.
METHODS: This study used a cross-sectional design and was conducted on 34 participants that undergoing periarticular surgery. This study compared the Wells, Caprini, and Padua scores test against hypercoagulation conditions confirmed by the D-dimer examination.
RESULTS: The correlation between Wells, Padua, Caprini scores, and D-dimer was 0.676, 0.023, and 0.395, respectively.
CONCLUSION: There was a significant relationship between the Padua scores and the D-dimer.
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14
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Jain N, Avanthika C, Singh A, Jhaveri S, De la Hoz I, Hassen G, Camacho L GP, Carrera KG. Deep Vein Thrombosis in Intravenous Drug Users: An Invisible Global Health Burden. Cureus 2021; 13:e18457. [PMID: 34745781 PMCID: PMC8563142 DOI: 10.7759/cureus.18457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/03/2021] [Indexed: 12/16/2022] Open
Abstract
The prevalence of intravenous drug use has increased in the past decade and it represents an important risk factor for deep vein thrombosis. Intravenous drug use is a global problem, with the main culprit being heroin. Peer pressure and poverty in high-risk groups such as sex workers, females, and young adults raise the risk of intravenous drug use, which expresses itself in the form of venous thromboembolism eventually. Deep vein thrombosis typically manifests itself eight years after the initial intravenous drug administration, rendering it a silent killer. Aiming to review and summarize existing articles in this context, we performed an exhaustive literature search online on PubMed and Google Scholar indexes using the keywords "Deep Venous Thrombosis (DVT)" and "Intravenous Drug Users (IVDU)." English articles that addressed epidemiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis, management, and outcomes of DVT, including those in IVDU, were selected and analyzed. The pathogenesis of DVT development in IVDU is mainly attributed to the interplay of trauma to the vessel by repeated injection and the injected drug itself. The right-sided femoral vein is the most common vein affected. Prevalent clinical presentations include local pain, swelling, and redness with typical systemic symptoms including fever, cough, dyspnea, and chest pain on top of addiction features. There appeared to be a delay in reporting symptoms, which was most likely due to the social stigma attached to IVDU. There are over 50 conditions that present with swollen and painful limbs comparable to DVT in IVDU, making precise diagnosis critical for timely treatment. Venous ultrasound is the method of choice for diagnosing DVT. Extended anticoagulant therapy with low-molecular-weight heparin combined with warfarin is the recommended treatment. Intravenous drug abusers having DVT are affected by multiple complications and poorer outcomes such as slower recovery, recurrent venous thromboembolism (VTE), and a longer hospital stay, which put them at higher risk of morbidity, mortality, reduced productivity, and economic burden.
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Affiliation(s)
- Nidhi Jain
- Medicine and Surgery, Himalayan Institute of Medical Sciences, Dehradun, IND
- Internal Medicine, Sir Ganga Ram Hospital, Delhi, IND
- Hematology and Oncology, Brooklyn Cancer Care, Brooklyn, USA
| | | | - Abhishek Singh
- Internal Medicine, Mount Sinai Morningside, New York, USA
| | - Sharan Jhaveri
- Internal Medicine, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
| | | | - Gashaw Hassen
- Medicine and Surgery, University of Parma, Parma, ITA
- Medicine, Addis Ababa University, Addis Ababa, ETH
- Progressive Care Unit, Mercy Medical Center, Baltimore, USA
| | - Genesis P Camacho L
- Division de Estudios para Graduados, Facultad de Medicina, Universidad del Zulia, Maracaibo, VEN
| | - Keila G Carrera
- Gastroenterology, Universidad de Oriente (VEN), Maturin, VEN
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15
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Dumantepe M. Endovascular Therapy for the Management of Acute Ilio-femoral Deep Vein Thrombosis. PHLEBOLOGIE 2021. [DOI: 10.1055/a-1519-9344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractIlio-femoral deep vein thrombosis (DVT) has a high rate of long-term morbidity in the form of the postthrombotic syndrome (PTS). Therefore, management of acute thrombosis should not only focus on the prevention of acute complications such as propagation or embolisation of the initial clot but also on preventing recurrent thrombosis and PTS. Contemporary catheter-based treatments of deep vein thrombosis have proven to be safe and effective in selected patients. Current guidelines recommend medical therapy with anticoagulation alone for all but the most severe, limb-threatening thrombosis. They additionally allow for consideration of endovascular catheter-based treatment in selected patients with acute proximal ilio-femoral DVT and low risk of bleeding complications to prevent PTS. Imaging-guided, catheter-based endovascular therapy has been used in selected patients to alleviate these sequelae, but important questions remain about their optimal use. In this article, we review the available evidence and summarize the rationale for use of catheter-based therapy in specific patient groups with acute iliofemoral DVT.
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Affiliation(s)
- Mert Dumantepe
- Uskudar University School of Medicine, Department of Cardiovascular Surgery, Istanbul, Turkey
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16
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Nomogram for Predicting Deep Venous Thrombosis in Lower Extremity Fractures. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9930524. [PMID: 34258284 PMCID: PMC8245242 DOI: 10.1155/2021/9930524] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/29/2021] [Indexed: 12/12/2022]
Abstract
Deep venous thrombosis (DVT) is a common complication in patients with lower extremity fractures, causing delays in recovery short-term and possible impacts on quality of life long-term. Early prediction and prevention of thrombosis can effectively reduce patient pain while improving outcomes. Although research on the risk factors for thrombosis is prevalent, there is a stark lack of clinical predictive models for DVT occurrence specifically in patients with lower limb fractures. In this study, we aim to propose a new thrombus prediction model for lower extremity fracture patients. Data from 3300 patients with lower limb fractures were collected from Wuhan Union Hospital and Hebei Third Hospital, China. Patients who met our inclusion criteria were divided into a thrombosis and a nonthrombosis group. A multivariate logistic regression analysis was carried out to identify predictors with obvious effects, and the corresponding formulas were used to establish the model. Model performance was evaluated using a discrimination and correction curve. 2662 patients were included in the regression analysis, with 1666 in the thrombosis group and 996 in the nonthrombosis group. Predictive factors included age, Body Mass Index (BMI), fracture-fixation types, energy of impact at the time of injury, blood transfusion during hospitalization, and use of anticoagulant drugs. The discriminative ability of the model was verified using the C-statistic (0.676). For the convenience of clinical use, a score table and nomogram were compiled. Data from two centers were used to establish a novel thrombus prediction model specific for patients with lower limb fractures, with verified predictive ability.
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17
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Ngarmukos S, Kim KI, Wongsak S, Chotanaphuti T, Inaba Y, Chen CF, Liu D. Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: Part 1. Diagnosis and risk factors. Knee Surg Relat Res 2021; 33:18. [PMID: 34147134 PMCID: PMC8214263 DOI: 10.1186/s43019-021-00099-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/04/2021] [Indexed: 12/11/2022] Open
Affiliation(s)
- Srihatach Ngarmukos
- Department of Orthopaedics, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu Seoul, Seoul, 134-727, Korea. .,Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea.
| | - Siwadol Wongsak
- Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thanainit Chotanaphuti
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - David Liu
- Gold Coast Centre for Bone & Joint Surgery, Gold Coast, Australia
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18
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Karaali E, Çiloğlu O, Demirtürk OS, Keklikçioğlu B, Akçay İ, Ekiz T. Increased deep vein thrombosis cases during the COVID-19 quarantine. Phlebology 2020; 36:114-118. [PMID: 33287673 DOI: 10.1177/0268355520977294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study was to compare the number of deep vein thrombosis (DVT) cases during the quarantine period for COVID-19 to that of the last year. METHODS This study was conducted as a single-center and retrospective study. All hospital admissions during April 2020 and May 2020 were screened from the hospital records, and DVT cases were recorded. Likewise, all hospital admissions during April 2019 and May 2019 were screened, and DVT cases were noted. DVT cases of both years were compared. RESULTS Among 480931 patients admitted to our hospital in April 2019 and May 2019, DVT was detected in 82 patients (0.017%) (47 males, 35 females) with a mean age of 56.99 ± 9.1 years (ranges 39 to 79 years). Besides, among 145101 patients admitted to our hospital in April 2020 and May 2020, DVT was detected in 123 patients (0.084%) (51 males, 72 females) with a mean age of 58.64 ± 8.9 years (ranges 40 to 83 years). Despite the decrease in the total number of patients admitted to the hospital, there was a significant increase in the number of DVT patients. Interestingly, there were only two symptomatic pulmonary-embolism cases in the 2019 period, whereas there were seven symptomatic pulmonary embolisms secondary to DVT in the 2020 period. Unfortunately, one patient died due to pulmonary embolism secondary to DVT in 2020. The previous history of DVT was remarkable in patients admitted during the COVID-19 confinement. CONCLUSION In conclusion, COVID-19 confinement seems to be associated with increased rates of DVT. Strict preventive measures such as exercise training or prophylactic drug use should be considered to prevent immobility-related DVT during the COVID-19 quarantine.
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Affiliation(s)
- Evren Karaali
- Department of Orthopedics and Traumatology, University of Health Science Adana City Training and Research Hospital, Adana, Turkey
| | - Osman Çiloğlu
- Department of Orthopedics and Traumatology, University of Health Science Adana City Training and Research Hospital, Adana, Turkey
| | | | - Burak Keklikçioğlu
- Department of Orthopedics and Traumatology, University of Health Science Adana City Training and Research Hospital, Adana, Turkey
| | - İsmail Akçay
- Department of Orthopedics and Traumatology, University of Health Science Adana City Training and Research Hospital, Adana, Turkey
| | - Timur Ekiz
- Department of Physical Medicine and Rehabilitation, Türkmenbası Medical Center, Adana, Turkey
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19
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Beller E, Becher M, Meinel FG, Kröger JC, Rajagopal R, Höft R, Weber MA, Heller T. Prevalence and predictors of alternative diagnoses on whole-leg ultrasound negative for acute deep venous thrombosis. BMC Med Imaging 2020; 20:127. [PMID: 33267839 PMCID: PMC7709303 DOI: 10.1186/s12880-020-00527-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/17/2020] [Indexed: 12/20/2022] Open
Abstract
Background To investigate the prevalence, spectrum, and predictors of alternative diagnoses explaining leg symptoms in patients negative for suspected acute deep venous thrombosis (DVT), which can be detected with whole-leg ultrasound. Methods We retrospectively analyzed a cohort of 789 patients (median age 70 years, 50.6% women) evaluated with a whole-leg ultrasound examination for suspected acute DVT within one year. All findings in the radiology report were analyzed and electronic chart review was performed to collect clinical information. Results Ultrasound was negative for acute DVT in 531 patients (67.3%). Among these, alternative diagnoses explaining leg symptoms were seen in 349 patients (65.7%). The most frequent alternative diagnoses were chronic venous insufficiency (147 patients, 27.7%), followed by lymphedema (48 patients, 9.0%) and chronic post-thrombotic changes (41 patients, 7.7%). Patients with alternative diagnoses were older (median 71 vs. 66 years, p = 0.0226), as well as more likely to present with leg swelling (39.5% vs. 23.1%, p = 0.0002), difference in leg circumference (25.5% vs. 14.8%, p = 0.0055) and redness (7.7% vs. 2.7%, p = 0.0213) than patients without alternative diagnosis. Independent predictors of finding alternative diagnoses on whole-leg ultrasound were older age (odds ratio 1.014 per year, p = 0.0119), leg swelling (OR 1.949, p = 0.0020) and history of previous DVT (OR 2.235, p = 0.0154). Conclusions Alternative diagnoses explaining leg symptoms can be detected on whole-leg ultrasound in two thirds of patients with no evidence of acute DVT. Our data supports performing a comprehensive ultrasound evaluation beyond the venous system, particularly, in older patients, who present with leg swelling and a past history of DVT.
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Affiliation(s)
- Ebba Beller
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Mattes Becher
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Felix G Meinel
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
| | - Jens-Christian Kröger
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | | | - Raimund Höft
- Department of Emergency Medicine, University Medical Centre Rostock, Rostock, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Thomas Heller
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
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20
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Morris RI, Sobotka PA, Balmforth PK, Stöhr EJ, McDonnell BJ, Spencer D, O'Sullivan GJ, Black SA. Iliocaval Venous Obstruction, Cardiac Preload Reserve and Exercise Limitation. J Cardiovasc Transl Res 2020; 13:531-539. [PMID: 32040765 PMCID: PMC7423854 DOI: 10.1007/s12265-020-09963-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/22/2020] [Indexed: 12/16/2022]
Abstract
Cardiac output during exercise increases by as much as fivefold in the untrained man, and by as much as eightfold in the elite athlete. Increasing venous return is a critical but much overlooked component of the physiological response to exercise. Cardiac disorders such as constrictive pericarditis, restrictive cardiomyopathy and pulmonary hypertension are recognised to impair preload and cause exercise limitation; however, the effects of peripheral venous obstruction on cardiac function have not been well described. This manuscript will discuss how obstruction of the iliocaval venous outflow can lead to impairment in exercise tolerance, how such obstructions may be diagnosed, the potential implications of chronic obstructions on sympathetic nervous system activation, and relevance of venous compression syndromes in heart failure with preserved ejection fraction.
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Affiliation(s)
- Rachael I Morris
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK.
| | - Paul A Sobotka
- The Ohio State University, Columbus, OH, USA
- V-Flow Medical Inc., Saint Paul, CA, USA
| | | | - Eric J Stöhr
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Centre, New York City, USA
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Barry J McDonnell
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | | | - Stephen A Black
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
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21
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Thukral S, Vedantham S. Catheter-Based Therapies and Other Management Strategies for Deep Vein Thrombosis and Post-Thrombotic Syndrome. J Clin Med 2020; 9:E1439. [PMID: 32408611 PMCID: PMC7290684 DOI: 10.3390/jcm9051439] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/07/2020] [Indexed: 02/07/2023] Open
Abstract
Acute deep vein thrombosis (DVT) causes substantial short-term and long-term patient morbidity. Medical, lifestyle, and compressive therapies have been investigated for the prevention of pulmonary embolism (PE) and recurrence of venous thromboembolism (VTE). However, patient-centered outcomes such as resolution of presenting DVT symptoms and late occurrence of post-thrombotic syndrome (PTS) have not been prioritized to the same degree. Imaging-guided, catheter-based endovascular therapy has been used in selected patients to alleviate these sequelae, but important questions remain about their optimal use. In this article, we review the available evidence and summarize the rationale for use of catheter-based therapy in specific patient groups.
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Affiliation(s)
- Siddhant Thukral
- School of Medicine, University of Missouri—Kansas City, Kansas City, MO 64108, USA;
| | - Suresh Vedantham
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO 63110, USA
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22
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Jafarzadeh-Esfehani R, Mostafa Parizadeh S, Sabeti Aghabozorgi A, Yavari N, Sadr-Nabavi A, Alireza Parizadeh S, Ghandehari M, Javanbakht A, Rezaei-Kalat A, Mahdi Hassanian S, Vojdanparast M, Ferns GA, Khazaei M, Avan A. Circulating and tissue microRNAs as a potential diagnostic biomarker in patients with thrombotic events. J Cell Physiol 2020; 235:6393-6403. [PMID: 32198752 DOI: 10.1002/jcp.29639] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/30/2020] [Indexed: 12/13/2022]
Abstract
Venous and arterial thrombosis are conditions that have a considerable burden if left untreated. The hypoxia-induced by the occluded vessel can disrupt the circulation of any organ, the cornerstone of treating thrombosis is rapid diagnosis and appropriate treatment. Diagnosis of thrombosis may be made by using laboratory tests or imaging techniques in individuals who have clinical manifestations of a thrombotic event. The use of serum micro ribonucleic acids (RNAs) has recently been applied to the diagnosis of thrombosis. These small RNA molecules are emerging as new diagnostic markers but have had very limited applications in vascular disease. Most of the articles provided various microRNAs with different levels of accuracy. However, there remains a lack of an appropriate panel of the most specific microRNA in the literature. The purpose of the present review was to summarize the existing data on the use of microRNAs as a diagnostic biomarker for venous thrombosis.
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Affiliation(s)
- Reza Jafarzadeh-Esfehani
- Department of Medical Genetics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Mostafa Parizadeh
- Department of Physiology, Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Physiology, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Negar Yavari
- Department of Physiology, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ariane Sadr-Nabavi
- Department of Medical Genetics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Alireza Parizadeh
- Department of Physiology, Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Ghandehari
- Department of Physiology, Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Physiology, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Afsane Javanbakht
- Department of Physiology, Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Physiology, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Afsaneh Rezaei-Kalat
- Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Mahdi Hassanian
- Department of Physiology, Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Vojdanparast
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Division of Medical Education, Brighton & Sussex Medical School, Brighton, UK
| | - Majid Khazaei
- Department of Physiology, Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Physiology, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Avan
- Department of Physiology, Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Physiology, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
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Kim J, Kim HJ, Park S, Kim DK, Kim TH. Predictive Factors of Deep Vein Thrombosis in Gynecologic Cancer Survivors with Lower Extremity Edema: A Single-Center and Retrospective Study. Healthcare (Basel) 2020; 8:healthcare8010048. [PMID: 32120824 PMCID: PMC7151164 DOI: 10.3390/healthcare8010048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/15/2020] [Accepted: 02/25/2020] [Indexed: 11/25/2022] Open
Abstract
This study was conducted to examine predictive factors of deep vein thrombosis (DVT) in gynecologic cancer survivors with lower extremity edema (LEE). In the current single-center, retrospective study, there was a total of 315 eligible patients, including 80 patients with DVT and 235 without DVT. They were therefore divided into two groups: the DVT group (n = 80) and the non-DVT group (n = 235). Then, baseline and clinical characteristics of the patients were compared between the two groups. In our study, distant organ metastasis, advanced stage, lymphadectomy, and amount of intraoperative blood loss had a positive predictive value for the occurrence of DVT in gynecologic cancer survivors presenting LEE. In conclusion, our results indicate that it is necessary to consider the possibility of LEE arising from DVT in gynecologic cancer survivors with advanced-stage cancer, distant organ metastasis, lymphadectomy, and intraoperative blood loss over 1500 mL.
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Affiliation(s)
- Jungin Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju 27478, Korea; (J.K.); (S.P.); (D.K.K.)
| | - Hyun-Jun Kim
- Department of Obstetrics & Gynecology, School of Medicine, Konkuk University, Chungju 27478, Korea;
- Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05029, Korea
| | - Seunghun Park
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju 27478, Korea; (J.K.); (S.P.); (D.K.K.)
| | - Dong Kyu Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju 27478, Korea; (J.K.); (S.P.); (D.K.K.)
| | - Tae Hee Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju 27478, Korea; (J.K.); (S.P.); (D.K.K.)
- Correspondence: ; Tel.: +82-43-840-8890; Fax: +82-43-840-8968
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Cai C, Guo Y, You Y, Hu K, Cai F, Xie M, Yang L, Ling K, Ye D, Misra S, Wang W, Li Y. Deep Venous Thrombosis in COVID-19 Patients: A Cohort Analysis. Clin Appl Thromb Hemost 2020; 26:1076029620982669. [PMID: 33372807 PMCID: PMC7783883 DOI: 10.1177/1076029620982669] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/09/2020] [Accepted: 12/02/2020] [Indexed: 12/24/2022] Open
Abstract
Deep venous thrombosis (DVT) is a severe complication of coronavirus disease 2019 (COVID-19). The purpose of this study was to study the prevalence, risk factors, anticoagulant therapy and sex differences of DVT in patients with COVID-19. The enrolled 121 hospitalized non-ventilator patients were confirmed positive for COVID-19. All suspected patients received color Doppler ultrasound (US) to screen for DVT in both lower extremities. Multivariate logistic regression was performed to identify risk factors related to DVT in COVID-19 patients. DVT was found in 48% of the asymptomatic COVID-19 patients with an increased PADUA or Caprini index using US scanning. The multivariate logistic regression determined that age (OR, 1.05; p = .0306), C-reactive protein (CRP) (OR, 1.02; p = .0040), and baseline D-dimer (OR, 1.42; p = .0010) were risk factors among COVID-19 patients. Although the most common DVT location was infrapopliteal (classes I and II), higher mortality in DVT-COVID-19 patients was confirmed. DVT-COVID-19 patients presented significant increases in CRP, neutrophil count, and D-dimer throughout the whole inpatient period compared to non-DVT-COVID-19 patients. Although anticoagulation therapy accelerated the recovery of lymphocytopenia in DVT patients, men DVT-COVID-19 patients with anticoagulant therapy showed significant higher CRP and neutrophil count vs. lymphocyte count (N/L) ratio, but showed lower lymphocyte counts compared to women DVT-COVID-19 patients. DVT is common in COVID-19 patients with high-risk factors, especially for older age and higher CRP and baseline D-dimer populations. It is important to consider sex differences in anticoagulant therapy among DVT-COVID-19 patients.
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Affiliation(s)
- Chuanqi Cai
- Department of Vascular Surgery, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
- Co-first authors
| | - Yi Guo
- Department of Vascular Surgery, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
- Co-first authors
| | - Yun You
- Department of Vascular Surgery, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
- Co-first authors
| | - Ke Hu
- Department of Vascular Surgery, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
| | - Fei Cai
- Department of Vascular Surgery, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China
| | - Lu Yang
- Microbiome Program, Center for Individualized Medicine, Mayo Clinic,
Rochester, MN, USA
- Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Ken Ling
- Department of Anesthesiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
| | - Dawei Ye
- Department of Cancer Center, Tongji Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
| | - Sanjay Misra
- Department of Radiology, Vascular and Interventional Radiology,
Translational Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Biochemistry and Molecular Biology, Mayo Clinic,
Rochester, MN, USA
- Department of Radiology, Vascular and Interventional Radiology, Mayo
Clinic, Rochester, MN, USA
| | - Weici Wang
- Department of Vascular Surgery, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiqing Li
- Department of Vascular Surgery, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
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Kalkan S, Yılmaz F, Yılmaz C, Izcı S, Emıroglu MY. Iliofemoral deep vein thrombosis caused by rare complication of orthopedic surgery. Thromb Res 2019; 184:136-138. [PMID: 31739152 DOI: 10.1016/j.thromres.2019.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Semih Kalkan
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey.
| | - Fatih Yılmaz
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Cemalettin Yılmaz
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Servet Izcı
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Yunus Emıroglu
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
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Dehbozorgi A, Damghani F, Mousavi-Roknabadi RS, Sharifi M, Sajjadi SM, Hosseini-Marvast SR. Accuracy of three-point compression ultrasound for the diagnosis of proximal deep-vein thrombosis in emergency department. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2019; 24:80. [PMID: 31620179 PMCID: PMC6788177 DOI: 10.4103/jrms.jrms_1057_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/05/2019] [Accepted: 06/03/2019] [Indexed: 11/08/2022]
Abstract
Background: This study aimed to assess the accuracy of three-point compression ultrasonography (3PCUS) performed for the diagnosis of proximal deep-vein thrombosis (DVT) in Emergency Department (ED) compared with the results of duplex US (DUS) (whole-leg compression ultrasound). Materials and Methods: The current prospective cross-sectional study with diagnostic test assessment was conducted on adult patients who were referred to the ED of a general teaching hospital in Shiraz, southern part of Iran (September 2016–May 2017), suspected of lower-extremity DVT, using a convenience sampling. The results of 3PCUS performed by ED residents were compared with the results of DUS performed by the radiology residents, which was considered as a criterion standard. Results: A total of 240 patients were enrolled, with a mean (standard deviation) age of 59.46 (16.58). 3PCUS has a sensitivity and a specificity of 100% (95% confidence interval [CI], 96.55%–100%) and 93.33% (95% CI, 87.72%–96.91%), respectively, in comparison with DUS (whole-leg compression ultrasound). Negative predictive value and positive predictive value were 100% and 92.11% (95% CI, 86.12%–95.64%), respectively, with an accuracy of 96.25% (95% CI, 93%–98.27%). Conclusion: The results of this study showed that 3PCUS of the lower extremities with a portable US machine, performed by the ED's residents, can accurately identify the presence or absence of lower-extremity DVT.
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Affiliation(s)
- Afsaneh Dehbozorgi
- Department of Emergency Medicine, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Damghani
- Department of Emergency Medicine, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mehrdad Sharifi
- Department of Emergency Medicine, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Mahmoudreza Sajjadi
- Department of Emergency Medicine, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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27
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Huang C, Tian J, Yuan C, Zeng P, He X, Chen H, Huang Y, Huang B. Fully Automated Segmentation of Lower Extremity Deep Vein Thrombosis Using Convolutional Neural Network. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3401683. [PMID: 31281832 PMCID: PMC6590596 DOI: 10.1155/2019/3401683] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/07/2019] [Accepted: 05/26/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Deep vein thrombosis (DVT) is a disease caused by abnormal blood clots in deep veins. Accurate segmentation of DVT is important to facilitate the diagnosis and treatment. In the current study, we proposed a fully automatic method of DVT delineation based on deep learning (DL) and contrast enhanced magnetic resonance imaging (CE-MRI) images. METHODS 58 patients (25 males; 28~96 years old) with newly diagnosed lower extremity DVT were recruited. CE-MRI was acquired on a 1.5 T system. The ground truth (GT) of DVT lesions was manually contoured. A DL network with an encoder-decoder architecture was designed for DVT segmentation. 8-Fold cross-validation strategy was applied for training and testing. Dice similarity coefficient (DSC) was adopted to evaluate the network's performance. RESULTS It took about 1.5s for our CNN model to perform the segmentation task in a slice of MRI image. The mean DSC of 58 patients was 0.74± 0.17 and the median DSC was 0.79. Compared with other DL models, our CNN model achieved better performance in DVT segmentation (0.74± 0.17 versus 0.66±0.15, 0.55±0.20, and 0.57±0.22). CONCLUSION Our proposed DL method was effective and fast for fully automatic segmentation of lower extremity DVT.
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Affiliation(s)
- Chen Huang
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
- Medical Imaging Institute of Panyu, Guangzhou, China
| | - Junru Tian
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- Shenzhen University Clinical Research Center for Neurological Diseases, Shenzhen, China
| | - Chenglang Yuan
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- Shenzhen University Clinical Research Center for Neurological Diseases, Shenzhen, China
| | - Ping Zeng
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- Shenzhen University Clinical Research Center for Neurological Diseases, Shenzhen, China
| | - Xueping He
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
- Medical Imaging Institute of Panyu, Guangzhou, China
| | - Hanwei Chen
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
- Medical Imaging Institute of Panyu, Guangzhou, China
| | - Yi Huang
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
- Medical Imaging Institute of Panyu, Guangzhou, China
| | - Bingsheng Huang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- Shenzhen University Clinical Research Center for Neurological Diseases, Shenzhen, China
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Lian Q, Hodges JS, Chu H. A Bayesian Hierarchical Summary Receiver Operating Characteristic Model for Network Meta-analysis of Diagnostic Tests. J Am Stat Assoc 2018; 114:949-961. [PMID: 31777410 DOI: 10.1080/01621459.2018.1476239] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
In studies evaluating the accuracy of diagnostic tests, three designs are commonly used, crossover, randomized, and non-comparative. Existing methods for meta-analysis of diagnostic tests mainly consider the simple cases in which the reference test in all or none of the studies can be considered a gold standard test, and in which all studies use either a randomized or non-comparative design. The proliferation of diagnostic instruments and the diversity of study designs create a need for more general methods to combine studies that include or do not include a gold standard test and that use various designs. This paper extends the Bayesian hierarchical summary receiver operating characteristic model to network meta-analysis of diagnostic tests to simultaneously compare multiple tests within a missing data framework. The method accounts for correlations between multiple tests and for heterogeneity between studies. It also allows different studies to include different subsets of diagnostic tests and provides flexibility in the choice of summary statistics. The model is evaluated using simulations and illustrated using real data on tests for deep vein thrombosis, with sensitivity analyses.
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Affiliation(s)
- Qinshu Lian
- Division of Biostatistics, School of Public Health, The University of Minnesota, Minneapolis, MN 55455
| | - James S Hodges
- Division of Biostatistics, School of Public Health, The University of Minnesota, Minneapolis, MN 55455
| | - Haitao Chu
- Division of Biostatistics, School of Public Health, The University of Minnesota, Minneapolis, MN 55455
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29
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Low-tube-voltage combined with adaptive statistical iterative reconstruction-V technique in CT venography of lower limb deep vein thrombosis. Sci Rep 2018; 8:11174. [PMID: 30042394 PMCID: PMC6057885 DOI: 10.1038/s41598-018-29519-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 07/11/2018] [Indexed: 12/11/2022] Open
Abstract
This study contains 2 arms: (1) the ASIR-V technique combined with low-tube-voltage in lower limb deep vein thrombosis (DVT) diagnosis was investigated; and (2) CT venography and ultrasound results in DVT diagnosis were compared. For arm 1, 90 patients suspected of DVT were randomly divided into 3 groups (30/group): groups A and B were scanned under 100-kV with pre-set ASIR-V weights of 30% and 50% respectively; group C were scanned under 70-kV with a 50% weight. For arm 2, 75 patients were divided into 3 groups (25/group), each group was CT scanned as in arm 1 and then all subjects were examined by ultrasound. Groups A, B and C had 16, 14 and 17 patients diagnosed with DVTs, respectively. There was no significant difference in subjective ratings of image quality among all groups. The 70-kV protocol remarkably increased venous attenuation value while all groups had similar DVT attenuation value. Higher noise was observed in group C, the CNR however, was actually augmented due to elevated venous attenuations. More importantly, group C had significantly lower CTDIvol and DLP values. In conclusion, the 70-kV protocol is superior to the 100 kV protocols, which was supported by findings from the second arm study.
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30
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Takechi D, Kuroda N, Dote H, Kim E, Yonekawa O, Watanabe T, Urano T, Homma Y. Better documentation in electronic medical records would lead to an increased use of lower extremity venous ultrasound in the inpatient setting: a retrospective study. Acute Med Surg 2017; 4:385-393. [PMID: 29123898 PMCID: PMC5649297 DOI: 10.1002/ams2.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/20/2017] [Indexed: 11/12/2022] Open
Abstract
Aim We hypothesized that the quality of the assessment of abnormal laboratory data in the emergency department (ED) could affect the hospital-attending physicians' decision-making after a patient's hospitalization. To test this hypothesis, we investigated how patients with a positive D-dimer result were reported by ED physicians in electronic medical records, and measured whether lower extremity venous ultrasonography examination was undertaken during hospitalization by the hospital-attending physicians. Methods In an urban tertiary acute care general hospital in Japan, between January 2012 and December 2013, we included patients hospitalized after a positive D-dimer measurement (≥1.0 μg/mL) that was taken in the emergency department. We retrospectively measured the quality of ED physician assessments. Then we examined whether that affected the decisions of attending physicians to order lower extremity venous ultrasonography examinations during hospitalization. The exposure variable was the quality of the ED physicians' assessment of patients with positive D-dimer results. The outcome was whether a lower extremity venous ultrasonography examination was ordered by the attending physician during hospitalization. Results When assessments were described by ED physicians for patients with positive D-dimer results, the attending physicians frequently ordered lower extremity venous ultrasonography (odds ratio, 10.74; 95% confidence interval, 5.92-19.50), even if the assessments only contained "copied and pasted" laboratory data (odds ratio, 1.68; 95% confidence interval, 2.10-2.40). Conclusions Better documentation by ED physicians, regarding patients with positive D-dimer results, strongly affected the decisions made by attending physicians to order lower extremity venous ultrasonography examination.
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Affiliation(s)
- Daisuke Takechi
- Department of General Internal Medicine Seirei Hamamatsu General Hospital Hamamatsu Shizuoka Japan
| | - Naoto Kuroda
- Department of General Internal Medicine Seirei Hamamatsu General Hospital Hamamatsu Shizuoka Japan
| | - Hisashi Dote
- Department of Emergency & Critical Care Medicine Seirei Hamamatsu General Hospital Hamamatsu Shizuoka Japan
| | - Euido Kim
- Department of General Internal Medicine Seirei Hamamatsu General Hospital Hamamatsu Shizuoka Japan
| | - Osamu Yonekawa
- Department of Laboratory MedicineSeirei Hamamatsu General Hospital Hamamatsu Shizuoka Japan
| | - Takuya Watanabe
- Department of General Internal Medicine Seirei Hamamatsu General Hospital Hamamatsu Shizuoka Japan
| | - Tetsumei Urano
- Department of Physiology Hamamatsu University School of Medicine Hamamatsu Shizuoka Japan
| | - Yoichiro Homma
- Department of General Internal Medicine Seirei Hamamatsu General Hospital Hamamatsu Shizuoka Japan
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31
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Diagnosis of Deep Venous Thrombosis at the Point-of-Care. CURRENT PULMONOLOGY REPORTS 2017. [DOI: 10.1007/s13665-017-0184-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Karande GY, Hedgire SS, Sanchez Y, Baliyan V, Mishra V, Ganguli S, Prabhakar AM. Advanced imaging in acute and chronic deep vein thrombosis. Cardiovasc Diagn Ther 2016; 6:493-507. [PMID: 28123971 PMCID: PMC5220209 DOI: 10.21037/cdt.2016.12.06] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 11/28/2016] [Indexed: 11/06/2022]
Abstract
Deep venous thrombosis (DVT) affecting the extremities is a common clinical problem. Prompt imaging aids in rapid diagnosis and adequate treatment. While ultrasound (US) remains the workhorse of detection of extremity venous thrombosis, CT and MRI are commonly used as the problem-solving tools either to visualize the thrombosis in central veins like superior or inferior vena cava (IVC) or to test for the presence of complications like pulmonary embolism (PE). The cross-sectional modalities also offer improved visualization of venous collaterals. The purpose of this article is to review the established modalities used for characterization and diagnosis of DVT, and further explore promising innovations and recent advances in this field.
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Affiliation(s)
| | - Sandeep S. Hedgire
- Division of Cardiovascular Imaging, Massachusetts General Hospital-Harvard Medical School, Boston, MA 02114, USA
| | - Yadiel Sanchez
- Department of Radiology, Massachusetts General Hospital-Harvard Medical School, Boston, MA 02114, USA
| | - Vinit Baliyan
- Division of Abdominal Imaging and intervention, Massachusetts General Hospital-Harvard Medical School, Boston, MA 02114, USA
| | - Vishala Mishra
- Division of Abdominal Imaging and intervention, Massachusetts General Hospital-Harvard Medical School, Boston, MA 02114, USA
| | - Suvranu Ganguli
- Division of Interventional Radiology, Massachusetts General Hospital-Harvard Medical School, Boston, MA 02114, USA
| | - Anand M. Prabhakar
- Division of Cardiovascular Imaging, Massachusetts General Hospital-Harvard Medical School, Boston, MA 02114, USA
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Akimoto T, Yamazaki T, Kusano E, Nagata D. Therapeutic Dilemmas Regarding Anticoagulation: An Experience in a Patient with Nephrotic Syndrome, Pulmonary Embolism, and Traumatic Brain Injury. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2016; 9:103-107. [PMID: 27840582 PMCID: PMC5096764 DOI: 10.4137/ccrep.s40607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/02/2016] [Accepted: 10/04/2016] [Indexed: 11/05/2022]
Abstract
Patients with active bleeding complications who concomitantly develop overt pulmonary embolism (PE) present distinct therapeutic dilemmas, since they are perceived to be at substantial risk for the progression of the embolism in the absence of treatment and for aggravation of the hemorrhagic lesions if treated with anticoagulants. A 76-year-old patient with nephrotic syndrome, which is associated with an increased risk of thromboembolism, concurrently developed acute PE and intracranial bleeding because of traumatic brain injury. In this case, we prioritized the treatment for PE with the intravenous unfractionated heparin followed by warfarinization. Despite the transient hemorrhagic progression of the brain contusion after the institution of anticoagulation, our patient recovered favorably from the disease without any signs of neurological compromise. Several conundrums regarding anticoagulation that emerged in this case are also discussed.
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Affiliation(s)
- Tetsu Akimoto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan
| | - Tomoyuki Yamazaki
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan
| | - Eiji Kusano
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan
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34
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Magetsari R, Dewo P, Nugroho AS, Lanodiyu Z. Deep Vein Thrombosis in Elderly Patients following Surgery for Fracture of the Proximal Femur. Malays Orthop J 2015; 8:7-10. [PMID: 26401228 DOI: 10.5704/moj.1411.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The incidence of Deep Vein Thrombosis (DVT) is high in orthopaedic cases, associated with morbidity and mortality. This study was done to evaluate the incidence of DVT and factors that contributed to DVT in elderly patients with proximal femur fracture who underwent surgery. Patients 60 years of age and older with proximal femur fracture who underwent surgery were enrolled into this study. Daily observation of the clinical signs of DVT was done post operatively until the subjects were discharged from the hospital. D-Dimer test and contrast venography were carried out on Day 2 and between Days 4 and 7 after surgery. Results were interpreted as normal and obstruction. There were 42 eligible patients, 18 of them (42.86 %) were diagnosed with DVT. We found that positive D-Dimer test (1.40), longer duration of surgery (1.86), and presence of clinical symptoms (1.09) increased the risk of the occurence of thrombosis although not statistically significant. There were four DVT patients who passed away within 4 months after surgery due to complication from DVT. The incidence of DVT in elderly with proximal femur fracture underwent surgery was relatively high (42.86 %) with the mortality rate was 22%.
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Affiliation(s)
- R Magetsari
- Department of Orthopaedics and Traumatology, Sardjito General Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - P Dewo
- Department of Orthopaedics and Traumatology, Sardjito General Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - A S Nugroho
- Department of Orthopaedics and Traumatology, Sardjito General Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Z Lanodiyu
- Department of Orthopaedics and Traumatology, Sardjito General Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia
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35
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DeCosta L, Guthrie JD. Role of B-color and Resolution Sonography Presets for the Diagnosis of Lower Extremity Deep Vein Thrombosis. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2015. [DOI: 10.1177/8756479314563540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sonography is an accurate and commonly used method of determining the presence, location, and acuity of deep vein thrombosis (DVT). A retrospective data analysis of 284 venous examinations was performed to determine if imaging presets increase the ability to detect an acute DVT. There were no significant differences between the outcomes of three modalities of sonographic imaging. If a patient had a prior DVT, the likelihood of observing another DVT using only two-dimensional imaging, resolution presets, or the B-color option was approximately nine times greater than for a patient who did not have a prior DVT. Sex, age, body mass index, ethnicity, and comorbidities of diabetes and/or hypertension were not significant predictors of observing a DVT. Using a resolution-enhancing preset that increases the overall frequency range to reduce artifacts and improve border definition and/or using the B-color preset to tint the overall image did not improve the likelihood of detecting an acute DVT during a lower extremity venous duplex sonogram.
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Yan S, Song C. An in-vitro study on corn-shaped balloon-enhanced thrombolysis. MINIM INVASIV THER 2014; 24:86-93. [PMID: 25055250 DOI: 10.3109/13645706.2014.942670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Glossy balloons were used to enhance deep vein thrombolysis. However, thrombi tend to yield in the balloon dilatation due to their smooth surface. It may be preferable to enhance thrombolysis by using balloons with a rough surface, instead of balloons with a smooth surface. MATERIAL AND METHODS Four rabbits were used for the experiment and 60 blood clot samples were obtained, and the samples were randomly separated into one control group and four balloon-solubilised groups. Urokinase solution (5000 U/ml) was used as the thrombolytic drug. The balloon-solubilised groups were enhanced respectively by 1 atm and 2 atm pressurised glossy balloons, and 1 atm and 2 atm pressurised corn-shaped balloons. Thrombolysis rates and residual rates for different granularities of blood clots were calculated for comparasion. RESULTS Thrombolysis rates of the groups using corn-shaped balloons were higher than those of the groups using glossy balloons (p = 0.003 and p = 0.002). Residual rates of Φ ≥ 3.7 mm blood clots for the groups using corn-shaped balloons were lower than those for the groups using glossy balloons (p < 0.001 and p < 0.001). CONCLUSION Balloons could be used to enhance thrombolysis; under the same balloon dilatation pressure, thrombolysis rates when using corn-shaped balloons are better than those when using glossy balloons.
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Affiliation(s)
- Shiju Yan
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology , Shanghai , China
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Abstract
A 69-year-old woman presented to the emergency department (ED) with a swollen left thigh and leg. D-dimer test was positive, a radiology department ultrasound showed no direct evidence of a deep venous thrombosis but a lack of respiratory modulation was seen. ED ultrasound showed large groin lymph nodes and this, together with low haemoglobin, prompted a CT scan which led to the diagnosis of metastatic carcinoma.
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Affiliation(s)
- Devesh Sharma
- Department of A&E Medicine, Frimley Park Hospital, Camberley, UK
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Maze MJ, Skea S, Pithie A, Metcalf S, Pearson JF, Chambers ST. Prevalence of concurrent deep vein thrombosis in patients with lower limb cellulitis: a prospective cohort study. BMC Infect Dis 2013; 13:141. [PMID: 23509908 PMCID: PMC3606326 DOI: 10.1186/1471-2334-13-141] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 02/26/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lower limb cellulitis and deep vein thrombosis share clinical features and investigation of patients with cellulitis for concurrent DVT is common. The prevalence of DVT in this group is uncertain. This study aimed to determine the prevalence of deep vein thrombosis (DVT) in patients with lower limb cellulitis and to investigate the utility of applying the Wells algorithm to this patient group. METHODS Patients admitted with lower limb cellulitis prospectively underwent a likelihood assessment for DVT using the Wells criteria followed by investigation with D-dimer and ultrasonography of ipsilateral femoral veins as appropriate. Diagnoses of contralateral DVT or pulmonary embolism during admission were recorded. RESULTS 200 patients assessed for DVT. 20% of subjects were high risk by Wells criteria. D-dimer was elevated in 74% and 79% underwent insonation of the affected leg. Ipsilateral DVT was found in 1 patient (0.5%) and non-ipsilateral VTE in a further 2 (1%). CONCLUSIONS Deep vein thrombosis rarely occurs concurrently with lower limb cellulitis. The Wells score substantially overestimates the likelihood of DVT due to an overlap of clinical signs. Investigation for DVT in patients with cellulitis is likely to yield few diagnoses and is not warranted in the absence of a hypercoaguable state. TRIAL REGISTRATION ACTRN: 12610000792022 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=320662).
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Affiliation(s)
- Michael J Maze
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, 8002, New Zealand.
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Wadajkar AS, Santimano S, Rahimi M, Yuan B, Banerjee S, Nguyen KT. Deep vein thrombosis: current status and nanotechnology advances. Biotechnol Adv 2012; 31:504-513. [PMID: 22940402 DOI: 10.1016/j.biotechadv.2012.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 08/13/2012] [Accepted: 08/14/2012] [Indexed: 12/12/2022]
Abstract
Deep vein thrombosis (DVT) affects up to 2 million people in the United States, and worldwide incidence is 70 to 113 cases per 100,000 per year. Mortality from DVT is often due to subsequent pulmonary embolism (PE). Precise diagnosis and treatment is thereby essential for the management of DVT. DVT is diagnosed by a thorough history and physical examination followed by laboratory and diagnostic tests. The choice of laboratory and diagnostic test is dependent on clinical pretest probability. Available laboratory and diagnostic techniques mainly involve D-dimer test, ultrasound, venography, and magnetic resonance imaging. The latter two diagnostic tools require high doses of contrast agents including either radioactive or toxic materials. The available treatment options include lifestyle modifications, mechanical compression, anticoagulant therapy, inferior vena cava filter, and thrombolysis/thrombolectomy. All of these medical and surgical treatments have serious side effects including improper clot clearance and increased risk of hemorrhage occurrence. Therefore, research in this field has recently focused on the development of non-invasive and accurate diagnostics, such as ultrasound enhanced techniques and molecular imaging methods, to assess thrombus location and its treatment course. The frontier of nanomedicine also shows high prospects in tackling DVT with efficient targeted drug delivery. This review describes the pathology of DVT along with successive medical problems such as PE and features a detailed listing of various diagnostic and therapeutic modalities that have been in use and are under development.
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Affiliation(s)
- Aniket S Wadajkar
- Department of Bioengineering, The University of Texas at Arlington, Arlington, TX 76019, USA
- Joint Biomedical Engineering Program between The University of Texas at Arlington and The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Sonia Santimano
- Department of Bioengineering, The University of Texas at Arlington, Arlington, TX 76019, USA
- Joint Biomedical Engineering Program between The University of Texas at Arlington and The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Maham Rahimi
- Department of Vascular Surgery, University of Cincinnati, OH 45267, USA
| | - Baohong Yuan
- Department of Bioengineering, The University of Texas at Arlington, Arlington, TX 76019, USA
- Joint Biomedical Engineering Program between The University of Texas at Arlington and The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Subhash Banerjee
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Kytai T Nguyen
- Department of Bioengineering, The University of Texas at Arlington, Arlington, TX 76019, USA
- Joint Biomedical Engineering Program between The University of Texas at Arlington and The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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40
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Pfeil A, Betge S, Poehlmann G, Boettcher J, Drescher R, Malich A, Wolf G, Mentzel HJ, Hansch A. Magnetic resonance VIBE venography using the blood pool contrast agent gadofosveset trisodium—An interrater reliability study. Eur J Radiol 2012; 81:547-52. [DOI: 10.1016/j.ejrad.2011.01.102] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 01/27/2011] [Accepted: 01/28/2011] [Indexed: 11/15/2022]
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Imberti D, Ageno W, Manfredini R, Fabbian F, Salmi R, Duce R, Gallerani M. Interventional treatment of venous thromboembolism: a review. Thromb Res 2011; 129:418-25. [PMID: 22119500 DOI: 10.1016/j.thromres.2011.11.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 10/17/2011] [Accepted: 11/02/2011] [Indexed: 02/06/2023]
Abstract
Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third most common cardiovascular disease after coronary artery disease and cerebrovascular disease and is responsible for significant morbidity and mortality in the general population. Full dose anticoagulation is the standard therapy for VTE, both for the acute and the long-term phase. The latest guidelines of the American College of Chest Physicians recommend treatment with a full-dose of unfractioned heparin (UFH), low-molecular-weight-heparin (LMWH), fondaparinux, vitamin K antagonist (VKA) or thrombolysis for most patients with objectively confirmed VTE. Catheter-guided thrombolysis and trombosuction are interventional approaches that should be used only in selected populations; interruption of the inferior vena cava (IVC) with a filter can be performed to prevent life-threatening PE in patients with VTE and contraindications to anticoagulant treatment, bleeding complications during antithrombotic treatment, or VTE recurrences despite optimal anticoagulation. In this review we summarize the currently available literature regarding interventional approaches for VTE treatment (vena cava filters, catheter-guided thrombolysis, thrombosuction) and we discuss current evidences on their efficacy and safety. Moreover, the appropriate indications for their use in daily clinical practice are reviewed.
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Affiliation(s)
- Davide Imberti
- Department of Internal Medicine, Piacenza Hospital, Italy.
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42
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Filho JS, Sayum J, de Carvalho RT, Nicolini A, Matsuda MM, Cheng WT, Cohen M. SUPRA AND INTRACONDYLAR OPEN FRACTURE OF THE FEMUR IN A MOTOCROSS ATHLETE: CASE REPORT. REVISTA BRASILEIRA DE ORTOPEDIA (ENGLISH EDITION) 2011; 46:602-4. [PMID: 27027061 PMCID: PMC4799298 DOI: 10.1016/s2255-4971(15)30419-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Accepted: 11/03/2010] [Indexed: 11/15/2022]
Affiliation(s)
- Jorge Sayum Filho
- Attending Physician at the Sports Traumatology Center (CETE), Department of Orthopedics and Traumatology, Federal University of São Paulo (Unifesp), São Paulo, SP, Brazil
- Correspondence: Rua França Pinto 186, apto. 61, Vila Mariana, 04016-001 São Paulo, SPCorrespondence: Rua França Pinto 186apto. 61Vila MarianaSão PauloSP04016-001
| | - Jorge Sayum
- Head Physician of the Department of Orthopedics and Traumatology, Assunção Hospital and Maternity Hospital (HMA), São Bernardo do Campo, SP, Brazil
| | - Rogério Teixeira de Carvalho
- Attending Physician at the Sports Traumatology Center (CETE), Department of Orthopedics and Traumatology, Federal University of São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Alexandre Nicolini
- Attending Physician at the Sports Traumatology Center (CETE), Department of Orthopedics and Traumatology, Federal University of São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Marcelo Mitsuro Matsuda
- Attending Physician at the Sports Traumatology Center (CETE), Department of Orthopedics and Traumatology, Federal University of São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Wu Tu Cheng
- Attending Physician in the Department of Orthopedics and Traumatology, Assunção Hospital and Maternity Hospital (HMA), São Bernardo do Campo, SP, Brazil
| | - Moisés Cohen
- Full Professor in the Department of Orthopedics and Traumatology, Unifesp; Head of the Sports Traumatology Center (CETE), São Paulo, SP, Brazil
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43
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Ji S, Fang W, Zhu M, Bai X, Wang C, Ruan C. Detection of pulmonary embolism with 99mTc-labeled F(ab)2 fragment of anti-P-selectin monoclonal antibody in dogs. TOHOKU J EXP MED 2011; 223:9-15. [PMID: 21187695 DOI: 10.1620/tjem.223.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pulmonary embolism is a common and potentially life-threatening condition, and its correct diagnosis is highly desirable before anticoagulant therapy is initiated. However, the safe and accurate diagnosis of acute pulmonary embolism remains a challenge. Single photon emission computed tomography (SPECT) is a highly sensitive scintigraphic imaging technique. Pulmonary embolism can be detected by SPECT with (99m)Tc-labeled imaging agents that bind to components present predominantly on thromboemboli. P-selectin is an adhesion glycoprotein that is expressed in platelets and endothelial cells. P-selectin on activated platelets is a suitable biomarker of the active thrombus process. The objective of this study was to evaluate (99m)Tc-labeled F(ab)(2) fragment of anti-P-selectin monoclonal antibody SZ51, (99m)Tc-SZ51-F(ab)(2), for imaging pulmonary embolism in beagle canines. SZ51 was digested to F(ab)(2) fragment, named SZ51-F(ab)(2), and its specific binding to P-selectin on either human or canine platelets was verified by flow cytometry assay. In each dog, an 18-gauge catheter was inserted into left or right pulmonary artery, and a two-stranded spiral stainless-steel coil (20 mm) was inserted through catheter. At 30 min after coil placement, X-ray angiography was performed to document the pulmonary embolism and the locations of the coil. After intravenous injection of (99m)Tc-SZ51-F(ab)(2), experimental thrombi in dogs could be consistently visualized for 2-3 hours by SPECT. Pulmonary embolism showed higher uptake of (99m)Tc-SZ51-F(ab)(2). The present study suggests that (99m)Tc-SZ51-F(ab)(2) may be a promising agent for detecting pulmonary embolism.
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Affiliation(s)
- Shundong Ji
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Key Laboratory of Thrombosis and Hemostasis, Ministry of Health, PR China
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Kesieme E, Kesieme C, Jebbin N, Irekpita E, Dongo A. Deep vein thrombosis: a clinical review. J Blood Med 2011; 2:59-69. [PMID: 22287864 PMCID: PMC3262341 DOI: 10.2147/jbm.s19009] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Indexed: 01/01/2023] Open
Abstract
Background: Deep vein thrombosis (DVT) is the formation of blood clots (thrombi) in the deep veins. It commonly affects the deep leg veins (such as the calf veins, femoral vein, or popliteal vein) or the deep veins of the pelvis. It is a potentially dangerous condition that can lead to preventable morbidity and mortality. Aim: To present an update on the causes and management of DVT. Methods: A review of publications obtained from Medline search, medical libraries, and Google. Results: DVT affects 0.1% of persons per year. It is predominantly a disease of the elderly and has a slight male preponderance. The approach to making a diagnosis currently involves an algorithm combining pretest probability, D-dimer testing, and compression ultrasonography. This will guide further investigations if necessary. Prophylaxis is both mechanical and pharmacological. The goals of treatment are to prevent extension of thrombi, pulmonary embolism, recurrence of thrombi, and the development of complications such as pulmonary hypertension and post-thrombotic syndrome. Conclusion: DVT is a potentially dangerous condition with a myriad of risk factors. Prophylaxis is very important and can be mechanical and pharmacological. The mainstay of treatment is anticoagulant therapy. Low-molecular-weight heparin, unfractionated heparin, and vitamin K antagonists have been the treatment of choice. Currently anticoagulants specifically targeting components of the common pathway have been recommended for prophylaxis. These include fondaparinux, a selective indirect factor Xa inhibitor and the new oral selective direct thrombin inhibitors (dabigatran) and selective factor Xa inhibitors (rivaroxaban and apixaban). Others are currently undergoing trials. Thrombolytics and vena caval filters are very rarely indicated in special circumstances.
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Affiliation(s)
- Emeka Kesieme
- Department of Surgery, Irrua Specialist Teaching Hospital, Irrua, Nigeria
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45
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Lifson AR, Belloso WH, Davey RT, Duprez D, Gatell JM, Hoy JF, Krum EA, Nelson R, Pedersen C, Perez G, Price RW, Prineas RJ, Rhame FS, Sampson JH, Worley J, INSIGHT Study Group. Development of diagnostic criteria for serious non-AIDS events in HIV clinical trials. HIV CLINICAL TRIALS 2010; 11:205-19. [PMID: 20974576 DOI: 10.1310/hct1104-205] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Serious non-AIDS (SNA) diseases are important causes of morbidity and mortality in the HAART era. We describe development of standard criteria for 12 SNA events for Endpoint Review Committee (ERC) use in START, a multicenter international HIV clinical trial. METHODS SNA definitions were developed based upon the following: (1) criteria from a previous trial (SMART), (2) review of published literature, (3) an iterative consultation and review process with the ERC and other content experts, and (4) evaluation of draft SNA criteria using retrospectively collected reports in another trial (ESPRIT). RESULTS Final criteria are presented for acute myocardial infarction, congestive heart failure, coronary artery disease requiring drug treatment, coronary revascularization, decompensated liver disease, deep vein thrombosis, diabetes mellitus, end-stage renal disease, non-AIDS cancer, peripheral arterial disease, pulmonary embolism, and stroke. Of 563 potential SNA events reported in ESPRIT and reviewed by an ERC, 72% met "confirmed" and 13% "probable" criteria. Twenty-eight percent of cases initially reviewed by the ERC required follow-up discussion (adjudication) before a final decision was reached. CONCLUSION HIV clinical trials that include SNA diseases as clinical outcomes should have standardized SNA definitions to optimize event reporting and validation and should have review by an experienced ERC with opportunities for adjudication.
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Affiliation(s)
- Alan R Lifson
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota 55454-1015, USA.
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[Importance of D-dimer testing in ambulatory detection of atypical and "silent" phlebothrombosis]. VOJNOSANIT PREGL 2010; 67:543-7. [PMID: 20707048 DOI: 10.2298/vsp1007543j] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM Deep venous thrombosis (DVT) is a life-threatening condition, which could be manifested with discrete symptoms (silent DVT). High mortality and disability of patients with DVT indicate the importance of early diagnosis, especially of "silent" DVT. The aim of this paper was to evaluate of reliability of early detection model for diagnosing DVT in ambulatory patients by using clinical probability of DVT presence, D-dimmer test (DD) and ultrasound evaluation (US). METHODS Ambulatory patients with suspected DVT were classified as "unlikely" and "likely" DVT by the Wells clinical model. The patients were randomly divided into the control and DD group. In the control group (629 patients) only US examination of lower limbs deep vein was done. All patients in the DD group (643 patients), with "unlikely" TDV, had DD, and in the positive patients US examination was done. In the "likely" patients US examination was done and negative US finding indicated DD test. Positive DD test was an indication for US examination after 7 days. The patients with initially excluded DVT were evaluated during 3 months. RESULTS A total number of 1 272 patients were examined; 117 (9.19%) patients were with DVT--62 (9.640%) in the DD and 55 (8.74%) in the control group. During the follow-up periods in the DD group (with 582 initially excluded DVT) we registered DVT in only one patient (0.17%). It was significantly lower (p < 0.05) compared to the control group where we registered 7 (1.10%) DVT (a group with 581 initially excluded DVT). The applied DD diagnostic strategy for 70.7% (p < 0.001) reduced the need for US examination. CONCLUSION The applied DD strategy in the diagnostic of DVT reduces the need for US examinations and reduces frequency of false negative results, with direct impact on cost and efficacy of procedures. DD diagnostic model should replace serial US examination in patients with suspect DVT.
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47
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Lin YT, Tsai IC, Tsai WL, Chen MC, Lin PC, Chan SW, Chen CCC. Comprehensive evaluation of patients suspected with deep vein thrombosis using indirect CT venography with multi-detector row technology: from protocol to interpretation. Int J Cardiovasc Imaging 2010; 26:311-22. [DOI: 10.1007/s10554-010-9688-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 08/13/2010] [Indexed: 10/19/2022]
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48
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Das Gupta E. An older woman with pain and swelling of left leg. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2010; 5:47-48. [PMID: 25606188 PMCID: PMC4170384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- E Das Gupta
- FRCP, International Medical University, Seremban, Malaysia (Esha Das Gupta)
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49
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Abstract
The association between venous thromboembolism and cancer has been recognized for over 140 years. This article reviews current prevention, diagnosis and treatment of cancer-related venous thromboembolism, and highlights emerging anticoagulants and the possible anticancer effects of anticoagulants such as low molecular weight heparins.
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Affiliation(s)
- Simon Noble
- Cardiff University and Royal Gwent Hospital, Wales NP20 2UB and
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50
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[Thromboembolic disease in orthopedic surgery]. Med Clin (Barc) 2009; 131 Suppl 2:18-24. [PMID: 19087846 DOI: 10.1016/s0025-7753(08)76444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Thromboembolic complications are frequent after orthopaedic surgery of the limbs. Strategies to minimize these complications go from recognize the risk factors of the patient to introduce new antithrombotic drugs, and including general medical care, regional anaesthesia and early mobilization. Based in epidemiological studies, prophylaxis must be extended 4-6 weeks in total hip and knee arthroplasty and in surgery of the hip fracture.
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